Before you begin any home strength training exercises, keep these tips in mind:
- You should feel comfortable with body positioning, moving through a comfortable range of motion, lifting the weight in a slow and controlled manner, lowering the weight in a slow and controlled manner, and breathing – exhale with exertion, do not hold your breath.
- For all exercises, take a deep breath and exhale during the lifting portion of the exercise and inhale as you return the weight to the starting position. Exercise in front of a mirror and use your own muscles to balance and sit as upright as possible.
- Start with a weight that you can lift for 12-15 repetitions. If you are able to perform more than 20 repetitions, the weight or resistance can be increased. If you are unable to reach 12 repetitions comfortably, the weight or resistance may be too heavy.
- If you have problems with balance or trunk instability, do not lift free weights over your head without a spotter or trainer.
- If you use a wheelchair, always use good stability techniques.
Lateral Stability
- Leaning – Stability may be increased by leaning toward the side of the wheelchair opposite the tipping direction.
- Holding – If possible, you can hold onto the wheelchair frame or wheel on the opposite side for stability. It may also be possible to hold onto a handrail or another piece of stationary fitness equipment.
- Use of a spotter – While lying back on a bench or raised mat area, the assistance of a spotter will help to prevent lateral tipping.
- Use of a strap – While lying back on a bench or raised mat area, a strap around the legs above the knees may be used to keep the legs positioned correctly.
Forward Stability
- Front wheel caster orientation – You can increase the stability of your wheelchair in the forward direction by moving your wheelchair backwards to rotate your front casters forward before locking your wheel-locks.
Rearward Stability
- Rear axle position – Many manual wheelchairs have adjustable axle positioning to move the rear wheels forward and backward. Be aware that if your wheelchair has the rear wheels positioned forward, making the wheelchair tippy, you may need to be very careful about tipping to the rear when exercising while seated in your wheelchair.
- Use of a spotter – Multiple exercises may cause rearward tipping, such as pushing weights forward or upward, or lifting weights above and behind the head. Having a trainer hold down the front of your wheelchair near the front casters or leg supports will prevent your wheelchair from tipping over to the rear while exercising.
- Use of weight on the foot support – A dumbbell can be placed on the foot support of the wheelchair to add extra weight to the front of the chair. This will help to reduce the tendency to tip to the rear while exercising in your wheelchair.
- Use of a restraint – A large plate that sits underneath all wheels of the wheelchair with two ratchet straps at the front can be used to hold down the front of the wheelchair during exercise. The wheelchair user can back onto the plate and the two straps are then hooked onto the frame of the wheelchair near the front casters to hold down the front of the wheelchair during exercise.
WARNING: If there is a crepitation or any popping inside the shoulder on any exercise, you should change the movement pattern so that this does not occur. If you do not have good shoulder stability, do not perform any exercises that cause your elbow to move above the height of your shoulder.
Shoulder Abduction
Caution: Lateral Instability
Muscles: Medial Deltoid, Supraspinatus
Note: Wrist weights can be used for individuals with liMited grip strength.
Grasp a dumbbell. Place the hand you are not lifting with on the chair, wheel, or another stationary object for stability. Sit up nice and tall with the arm extended down at your side, palm facing in. Keeping the upper body stationary, take a deep breath in and exhale as you extend the arm out to the side, slightly in front of the body, and raise to shoulder level. Keep a slight bend in the elbow, the hand in line with the arm. Do not use jerking or swinging motions. Inhale as you reverse the direction and allow the arm to slowly go back down to the starting position. Repeat with the opposite arm. This exercise can also be performed with the elbows bent 90 degrees. Performing this exercise with the thumb pointed down will engage the supraspinatus muscle which is part of the rotator cuff that provides the shoulder with stability.
Medial deltoid shoulder abduction: Can be performed with two dumbbells at the same time. Hold the dumbbells at your side with your elbows bent 90 degrees. Raise your elbows slowly until they are even with your shoulders. Then lower your elbows back down to your side slowly.
External rotation shoulder abduction: Start with your arm hanging down by your side. Lift your arm up to shoulder level keeping in line with the side of your leg with your thumb pointing up.
Supraspinatus shoulder abduction: Start with your arm hanging down by your side. Starting with a much lighter weight, lift up your arm to shoulder level keeping in line with the side of your leg with your thumb pointing down. This strengthens an important rotator cuff muscle that will help stabilize your shoulder.
Shoulder Adduction
Muscles: Pectoralis Major
Grip the ends of the Flex Bar with both hands. Hold the Flex Bar chest high, elbows out to the sides. Take a deep breath in, exhale and bend the Flex Bar down moving the elbows toward the body. Inhale as you raise elbows back up to the starting position.
Upright Row
Muscles: Deltoids, Trapezius, Biceps Brachii
Start with your arms down at either side in front of you, palms facing back. Use a strap to support your upper body if needed. Exhale and bend your elbows to bring your hands up to your armpits. Keep your hands close to the body through the motion. Inhale and slowly lower to the starting position.
Note: Individuals with a complete injury at or above the C6 level may not be able to perform this movement.
Bicep Curl
Caution: Lateral or Forward Instability
Muscles: Biceps Brachii, Brachioradialis, Brachialis
Start with one arm extended at your side, palm facing up, grasping the dumbbell. If needed, remove the side guard or arm support of your wheelchair or transfer onto a bench in order to perform the movement with a full range of motion. Keeping the upper arm and upper body stationary, take a deep breath in. Exhale and flex the elbow, raising the forearm towards the shoulder. Do not jerk or swing the dumbbell upward. Inhale as you reverse the direction, slowly extending the weight back to the starting position. Lean toward the opposite side of your wheelchair to increase your lateral stability as well. If possible, you can hold onto the wheelchair frame or wheel on the opposite side for stability. It may also be possible to hold onto a handrail or another piece of fitness equipment to assist with your lateral stability. Repeat with the opposite arm.
Bicep Curl
Muscles: Triceps Brachii
Place the hand you are not lifting with on the chair, wheel, or another stationary object for stability and to allow you to slightly lean forward. With one hand grasping the hand grip of the free weight or cable resistance, move the elbow behind the midline of the body, keeping the arm at 90 degrees. Take a deep breath in. Exhale and flex the elbow and inhale as you return the forearm to the starting position. Repeat with the opposite arm.
External Rotation Row and Bent Over Row
Caution: Lateral or Forward Instability
Muscles: Trapezius, Posterior Deltoid
For wheelchair users, the most effective row can be performed on a weight bench or by leaning forward on your thighs if you have the core strength.
External Rotation Row
With the elbow raised even with the shoulder as shown on the right, raise the hand forward until the hand is level with the shoulder.
Bent Over Row
Starting with the arms extended fully down toward the floor, pull your elbows up and back pinching your shoulder blades together as shown on the right. If you have the core strength, you can also lean forward with your chest on your lower legs to perform this exercise.
Reclined Pectoral Fly
Caution: Lateral Instability
Muscles: Pectoralis Major
Transfer to a bench or raised mat area. Lie on your back, keeping the spine neutral and your head remaining on the surface. A strap around the legs above the knees may be used to keep the legs positioned correctly when lying back on the surface. You may need an assistant to hand you the dumbbells after you are positioned correctly. With weights in your hands and arms extended out to the sides, exhale and bring both arms together over your chest. Keep a consistent slight bend in the elbow throughout the motion and do not jerk or swing the weight up. If you cannot maintain your arms in the same extended, slightly bent position throughout the movement, a lower weight should be used. Inhale as you slowly allow your arms to return to the starting position. A strap around the legs, below or above the knees, may be used.
Lying Abdominal Crunches
Caution: Lateral Instability
Muscles: Rectus Abdominus, Transverse Abdominus
Position yourself facing up, on a flat or declined bench, or a flat mat. If possible, bend knees while keeping feet flat on the floor. A strap around the legs above the knees may be used to keep the legs positioned correctly when lying back on the bench. An additional strap can be used to secure the feet to the surface or have a spotter assist by holding the feet down. While lying down with shoulder blades and neck in alignment with the body, exhale and curl up. Allow shoulder blades to come up off the surface and keep your eyes focused on the ceiling directly overhead. Inhale as you slowly return to the starting position, allowing shoulder blades to return to the surface.
Note: For individuals with a spinal cord injury, this exercise can be performed using a counter-weight such as a medicine ball thrown over head or resistance band positioned around a secure object.
Sources:
Discover Accessible Fitness: A Wheelchair User’s Guide for Using Fitness Equipment (2014). Retrieved from https://www.nchpad.org/discoverfitness/files/inc/084021749b.pdf
Life on Wheels: A Guide for a Healthy Life with a Spinal Cord Injury (n.d.) Retrieved from https://www.nchpad.org/fppics/Life%20on%20Wheels%20final%20version%20web.pdf
Robinson, L. & Segal, J. (2019). How to Exercise with Limited Mobility. Retrieved from https://www.helpguide.org/articles/healthy-living/chair-exercises-and-limited-mobility-fitness.htm
U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Human Services